1274. Use of Rapid Influenza Diagnostic Tests: Impact on Treatment of Hospitalized Influenza Cases, New York – 2012-2015
Session: Poster Abstract Session: Clinical Infectious Diseases: Respiratory Infections
Friday, October 28, 2016
Room: Poster Hall
Posters
  • Flu poster IDWEEK2016.pdf (435.0 kB)
  • Background: While rapid influenza diagnostic test (RIDT) results assist clinicians in treatment decisions, due to low sensitivity of the tests, exclusively relying on RIDT results may compromise decisions on antiviral treatment.

    Methods: The New York State Department of Health’s Emerging Infections Program conducts active population-based surveillance for all laboratory-confirmed hospitalized influenza cases from eight Albany area counties through the CDC Influenza-Associated Hospitalizations Surveillance Network (FluSurv-NET). To ensure ascertainment of all cases, hospital laboratories are encouraged to submit both RIDT positive and negative specimens for patients hospitalized with influenza-like illness (ILI) to the Wadsworth Center (WC) for PCR testing. The association between test results recorded at the hospital laboratories and use of antiviral drug treatment was measured using multiple logistic regression.

    Results: During three influenza seasons (2012/13, 2013/14, 2014/15), a total of 1,992 hospitalized influenza patients were identified. Of these, 382 (19.2%) patients initially tested negative by RIDT at the hospital laboratory but later confirmed as PCR+ at WC. Overall, 560 (28.1%) patients were not treated with antivirals. After adjusting for patient age, a positive test result at the hospital laboratory was the most significant variable driving the use of antiviral treatment.

      OR

      CI

      Positive test result at hospital laboratory

      39.93a

      27.97 – 58.16

      Presence of three ILI symptoms at admission

      4.66a

      2.60 – 8.34

      Presence of two ILI symptoms at admission

      2.63b

      1.54 – 4.41

      Admission within 48 hours of symptom onset

      1.39b

      1.06 – 1.83

      Age (Unit = 10 years)

      1.09b

      1.04 – 1.15

    aP = <0.001, bP = <0.05

    Conclusion: Despite guidance from CDC advising clinicians not to rely on RIDT results for influenza treatment decisions, our results show that a test result from the hospital laboratory, commonly a RIDT, is the major predictor of a clinician’s decision to prescribe antiviral treatment. Further, our data demonstrate that, as a result, 16.1% of true influenza infections in hospitalized patients went untreated. This finding highlights the need for clinicians to be further educated about the limitations of RIDT for treatment management decisions.

    Eva Pradhan, MPH, MHA1, Suzanne Mcguire, MPH1, Nancy L. Spina, MPH1, Priscela Perez, MPH1, Jemma Rowlands, MPH1, Gregory Farrell, BA2, Kristen St. George, PhD2 and Shelley M. Zansky, PhD1, (1)New York State Department of Health, Albany, NY, (2)Wadsworth Center, New York State Department of Health, Albany, NY

    Disclosures:

    E. Pradhan, None

    S. Mcguire, None

    N. L. Spina, None

    P. Perez, None

    J. Rowlands, None

    G. Farrell, None

    K. St. George, Zeptometrix: Collaborator , Licensing agreement or royalty and Royalty paying collaborative agreement – pays royalties to the laboratory not to me personally.
    ThermoFisher: Collaborator , Research support and Supply of equipment and reagents
    Akonni Biosystems: Research partner in multiple SBIR NIH-funded grants , Research support

    S. M. Zansky, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.